Glickman Seth W, Granger Christopher B, Ou Fang-Shu, O'Brien Sean, Lytle Barbara L, Cairns Charles B, Mears Greg, Hoekstra James W, Garvey J Lee, Peterson Eric D, Jollis James G
Duke Clinical Research Institute, Durham, NC 27599, USA.
Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):514-21. doi: 10.1161/CIRCOUTCOMES.109.917112. Epub 2010 Aug 31.
Prior studies have demonstrated differences in time to reperfusion for ST-segment-elevation myocardial infarction (STEMI) in women, minorities, and the elderly, relative to their counterparts. Regionalization has been shown to improve overall STEMI treatment times, but its impact on care differences among these important patient subgroups is unknown. The objective of this analysis was to assess the impact of a statewide system of STEMI care (The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments) on treatment times according to patient sex, race, and age.
STEMI treatment times were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of coordinated regional treatment protocols. Times in the pre- and postintervention periods were compared by mixed-effects models. A total of 2063 STEMI patients were analyzed: 1140 at percutaneous coronary intervention hospitals and 923 at non-percutaneous coronary intervention hospitals. The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments was associated with significant improvements in treatment times in women and the elderly, including door-to-ECG, door-to-device, door-in-door-out, and door-to-needle times (all P<0.05). Temporal improvements in treatment times at percutaneous coronary intervention hospitals were not significantly different in blacks than in whites. There was a reduction in baseline treatment disparities in door-to-ECG times in women versus men (4.4-minute reduction in difference; 95% CI, -8.1 to -0.4; P=0.03). After Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, an age-treatment time gap persisted in the elderly, relative to younger patients.
A statewide STEMI regionalization program was associated with comparable improvement in treatment times for female, black, and elderly patients compared with middle-aged, white male patients. Nevertheless, there remain opportunities to further narrow treatment differences, particularly among the elderly.
既往研究表明，与男性、少数族裔和老年人相对应的女性、少数族裔和老年人在ST段抬高型心肌梗死（STEMI）再灌注时间上存在差异。区域化已被证明可改善整体STEMI治疗时间，但其对这些重要患者亚组护理差异的影响尚不清楚。本分析的目的是评估全州STEMI护理系统（北卡罗来纳州急诊科急性心肌梗死再灌注）对患者性别、种族和年龄的治疗时间的影响。
在为期一年的协调区域治疗方案实施之前（2005年7月至2005年9月）和之后（2007年1月至2007年3月）确定STEMI治疗时间。通过混合效应模型比较干预前后的时间。共分析了2063例STEMI患者：1140例在经皮冠状动脉介入治疗医院，923例在非经皮冠状动脉介入治疗医院。北卡罗来纳州急诊科急性心肌梗死再灌注与女性和老年人治疗时间的显著改善相关，包括门到心电图、门到器械、门进出门出和门到针时间（均P<0.05）。经皮冠状动脉介入治疗医院治疗时间的时间改善在黑人与白人之间无显著差异。女性与男性在门到心电图时间上的基线治疗差异有所减少（差异减少4.4分钟；95%CI，-8.1至-0.4；P=0.03）。在北卡罗来纳州急诊科急性心肌梗死再灌注后，老年人与年轻患者相比，年龄与治疗时间的差距仍然存在。
与中年白人男性患者相比，全州STEMI区域化项目在女性、黑人及老年患者的治疗时间改善方面具有可比性。然而，仍有机会进一步缩小治疗差异，尤其是在老年人中。
